Healthcare Provider Details

I. General information

NPI: 1649109026
Provider Name (Legal Business Name): EVAN DUBEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 JAVA ST STE 209
BROOKLYN NY
11222-5519
US

IV. Provider business mailing address

540 MAIN ST APT 474
NEW YORK NY
10044-0176
US

V. Phone/Fax

Practice location:
  • Phone: 646-801-0378
  • Fax:
Mailing address:
  • Phone: 616-329-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: